Document Type : Brief Report


1 Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran

2 Shefa Neuroscience Research Center, Khatam-al-Anbya Hospital, Tehran, Iran

3 Anesthesiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

4 Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

5 Tehran Emergency Medical Service Center, Tehran, Iran


Objective: The current study was performed to provide real-time bedside ultrasonography for emergency medical technicians (EMTs) and assess the advantages and disadvantages of its application in dealing with trauma patients in pre-hospital setting from their viewpoints.
Methods: This semi-experimental study was conducted in Tehran, Iran. Twenty EMTs were selected purposefully and underwent a training program. Thereafter, they were asked to perform extended focused assessment with sonography in trauma (eFAST) using a handheld ultrasound device on trauma patients, and also filled a questionnaire prepared (in four components including C1: coherence, C2: cognitive participation, C3: collective action, and C4: reflexive monitoring) based on the normalization process theory (NPT).
Results: All 20 participants were men and their average age was 37.8 years (SD = 4.7). For C1, the median total score was 10.5 out of a score of 4-20; For C2, the median score was 6 out of 3-15; For C3, the median total score was 18 out of a score of 6-30; and for C4, the median total score was 11 out of a score of 5-25.
Conclusion: Overall, it seems that EMTs welcomed using ultrasonography in dealing with trauma patients in pre-hospital setting. Although they thought that it might somewhat lead to an increase in their workload; but they believed that sufficient training was not provided for them yet. The EMTs were uncertain about the viewpoints of the patients and did not know how it could affect patients’ outcome.


Main Subjects

1. Abdolrazaghnejad A, Banaie M, Safdari M. Ultrasonography in emergency department; a diagnostic tool for better examination and decision-making. Adv J Emerg Med 2018; 2(1): e7. doi: 10.22114/AJEM.v0i0.40.
2. Heydari F, Ashrafi A, Kolahdouzan M. Diagnostic accuracy of focused assessment with sonography for blunt abdominal trauma in pediatric patients performed by emergency medicine residents versus radiology residents. Adv J Emerg Med 2018; 2(3): e31. doi: 10.22114/AJEM.v0i0.89.
3. Samuel AE, Chakrapani A, Moideen F. Accuracy of extended focused assessment with sonography in trauma (e-FAST) performed by emergency medicine residents in a level one tertiary center of India. Adv J Emerg Med 2018; 2(2): e15. doi: 10.22114/ajem.v0i0.69.
4. Bagheri‑Hariri S, Bahreini M, Farshidmehr P, Barazandeh S, Babaniamansour S, Aliniagerdroudbari E, et al. The effect of extended-focused assessment with sonography in trauma results on clinical judgment accuracy of the physicians managing patients with blunt thoracoabdominal
trauma. Arch Trauma Res 2019;8(4):207-13. doi: 10.4103/atr.atr_57_19.
5. Roantree RAG, Furtado CS, Lambert MJ. EMS, Ultrasound Use. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2020.
6. El Zahran T, El Sayed MJ. Prehospital ultrasound in trauma:a review of current and potential future clinical applications. J Emerg Trauma Shock 2018; 11(1): 4-9. doi: 10.4103/jets.jets_117_17.
7. Price DD, Wilson SR, Murphy TG. Trauma ultrasound feasibility during helicopter transport. Air Med J 2000;19(4): 144-6. doi: 10.1016/s1067-991x(00)90008-7.
8. Melanson SW, McCarthy J, Stromski CJ, Kostenbader J, Heller M. Aeromedical trauma sonography by flight crews with a miniature ultrasound unit. Prehosp Emerg Care 2001; 5(4): 399-402. doi: 10.1080/10903120190939607.
9. Murray E, Treweek S, Pope C, MacFarlane A, BalliniL, Dowrick C, et al. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med 2010; 8: 63. doi:10.1186/1741-7015-8-63.
10. Normalization Process Theory 2020. [Cited 28 May 2019]. Available from:
11. Walcher F, Weinlich M, Conrad G, Schweigkofler U, Breitkreutz R, Kirschning T, et al. Prehospital ultrasound imaging improves management of abdominal trauma. Br J Surg 2006; 93(2): 238-42. doi: 10.1002/bjs.5213.
12. Byhahn C, Bingold TM, Zwissler B, Maier M, Walcher F. Prehospital ultrasound detects pericardial tamponade in a pregnant victim of stabbing assault. Resuscitation 2008; 76(1): 146-8. doi: 10.1016/j.resuscitation.2007.07.020.
13. Heegaard W, Hildebrandt D, Reardon R, Plummer D, Clinton J, Ho J. Prehospital ultrasound diagnosis of
traumatic pericardial effusion. Acad Emerg Med 2009; 16(4): 364. doi: 10.1111/j.1553-2712.2009.00379.x.
14. Roberts J, McManus J, Harrison B. Use of ultrasonography to avoid an unnecessary procedure in the prehospital combat environment: a case report. Prehosp Emerg Care 2006; 10(4): 502-6. doi: 10.1080/10903120600887023.
15. Chin EJ, Chan CH, Mortazavi R, Anderson CL, Kahn CA, Summers S, et al. A pilot study examining the viability of a Prehospital Assessment with UltraSound for Emergencies (PAUSE) protocol. J Emerg Med 2013; 44(1): 142-9. doi:10.1016/j.jemermed.2012.02.032.
16. Lyon M, Walton P, Bhalla V, Shiver SA. Ultrasound detection of the sliding lung sign by prehospital critical
care providers. Am J Emerg Med 2012; 30(3): 485-8. doi: 10.1016/j.ajem.2011.01.009.
17. Krogh CL, Steinmetz J, Rudolph SS, Hesselfeldt R, Lippert FK, Berlac PA, et al. Effect of ultrasound training of physicians working in the prehospital setting. Scand J Trauma Resusc Emerg Med 2016; 24: 99. doi: 10.1186/s13049-016-0289-1.
18. Gracias VH, Frankel HL, Gupta R, Malcynski J, Gandhi R, Collazzo L, et al. Defining the learning curve for the Focused Abdominal Sonogram for Trauma (FAST) examination: implications for credentialing. Am Surg 2001; 67(4): 364-8.
19. Bobbia X, Hansel N, Muller L, Claret PG, Moreau A, Genre Grandpierre R, et al. Availability and practice of bedside ultrasonography in emergency rooms and prehospital setting: a French survey. Ann Fr Anesth Reanim 2014;33(3): e29-33. doi: 10.1016/j.annfar.2013.12.010.
20. Ketelaars R, Reijnders G, van Geffen GJ, Scheffer GJ, Hoogerwerf N. ABCDE of prehospital ultrasonography: a narrative review. Crit Ultrasound J 2018; 10(1): 17. doi:10.1186/s13089-018-0099-y.